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121 Camp St #105 Building Permits
• z. Of V TOWN OF YARMOUTH Building Department (508) 398-2231 ext.261 BUILDING ►- PERMIT NO - - --06- - - - - - PERMIT k ISSUE DATE ;- 9/29/2005 ROPO ED Us - _ _ - - - - _ _ _ , APPLICANT Frank Capra JOB WEATHER CARD PERMIT TO ; New Construction ; AT (LOCATION) 00121 CAMP ST Unit 105 ZONING DISTRIC R-2 Bldg. Type: Residential SUBDIVISION MAP LOT BLOCK 1044.21A.C105 BUILDING IS TO BE: CONST TYPE 5-B jUSE GROUP R-4 LOT SIZE �� new construction: 2 baths, 3 bedrooms, 1 kitchen/dining area, 1 livingroom as per plans dated REMARKS 08/30/05. NOTE: SUBJECT TO COMPACTION AND PROCTOR TESTS AREA (SO FT) EST COST ($ 1$146,400.00 PLKMI I t-tt t4l) laaK+•uv OWNER I Villages @ Camp Street, LLC BUILDING DEPT BY ADDRESS 11600 Falmouth Road # 25 Centerville I MA 102632 INSPECTION RECORD CONTRACTOR LICENSE 012430 Capra, Frank 1600 Falmouth Road #25 Centerville MA 02632 5087789669 FIELD COPY �/_ !/i_ i. ✓.. u, Liu. r _.:�_i �%. ,, �i�/1�.. .... _ u of YgR ONE & TWO FAMILY ONLY - BUILDING PERMIT fp APPLICATION TO CONSTRUCT, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING p Town of Yarmouth Building Department N „„r„EE, T 1146 Route 28 • Yarmouth, MA 02664-4492 Tel: (508) 398-2231 x261 Fax: (508) 398-0836 +ce Use Only y' .� + Iann+ng Board lnformat+an p8 Assessors Department information Map 'Lot;Map" -' Permit No a d! a/Q� , NewPermit q X �Rec ate En rsementDate g Datesions Depbsit Recd P No ;'1ot'Area{sf) Froptage{ft) - Lot Coverage NefDUe _.$_er ,__ % ThY f +s Section' fior O�ce`Use Onl Suildin Permit tube Date Issued a Certlflcate of Occupancy =A = rs +s.nijt J FequirecJ Slgriature Date, Building Official ,. , Section 1= Site Information< Use Group: R-4 Type: 5-B 1.1 Property Address: 1.2. Zoning Information: ;Proposed 21 G4-aye' S-r Y'e� %i 9t— z(96 Zoning District 1.3 Building Setbacks (it) Front Yard Side Yards _ Rear Yard Required Provided Required Pro`videcl rr 1r� Required Provided ` 1.4 Water supply (IIc. 40. S 54) 1.5 Flood Zone,IntQ�mation Commentsi � rZone: Public Private Section 2' ;Property Ownership/Authorized Agent 2.1 w� r of Record. `� Mailing AddressC�-�i^�/l'/G_} Name (pri�q • ��j2 7, q- 6 Telephone Signature l 2.2 AutthorizvdtAgent,, / h Mailing Addressc�%//j� Na print) Signature Telephone Section 3 = Coristructiori Services; 3.1 Licensed Construction Supervisor: ' i I: � 5 005 1 Not Applicable ❑ r � License Number /� /Z T � 0 Addr 0 Expiration Date Signature Telephone y 3'2 Registered Home'Improvement='ContrActor-" Not Applicable Company Name License Number Address Expiration Date Si nature Telephone g OVER- 9-15-99 iof2 Z MMUCIVµ lm:u.t: o: i 2 525C (6)1 v Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure, Ito provide this affidavit will result in the denial of the issuance of the building permit. Signed Affidavit Attached Yes ...... _ Section 57Description of Pr000sed,Work check afJ applicable) New construction Existing Bldg. ElRepair(s) No. of Bedrooms LY No. of Bathrooms Z ❑ Alterations ❑ Addition ❑ Accessory Bldg. ❑ Type Demolition Other Specify: Brief Description of Proposed Work: e� tN Q G . , e1C I hereby authorize my behalf, in all i Q Check Below ❑ Conservation -Commission Filing (if applicable) ❑ Old Kings Highway & Historical Commission approval (if applicable) , as owner of the subject property rela ' e to w rk authorized by this building permit application. Date to act on , as Owner/Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief. Signed under the pains and penalties of perjury. . c• I-19111 1,611 IC - __4aL� &�L �� Sig at of O ner/ gent: Date 9-15-99 2 of 2 ~ � M The Commonwealth of Massachusetts Department of Industrial Accidents Office oUSYLIS fpsiyiis 600 Washington Street Boston. Mass. 02111 Workers' Compensation Instimneo srr.t.,.;. city W1 63� - nhnn�j fl U I 0 1 am a homeowner pertormmg all work myself. I.am a sole proprietor zrd ha%a no one w•orkina in any capacity lam .an employer pro,. iding workers' compensation for my employees working on this job. comrany name; address: city - a insurance co. notice 0 am a sole proprietor. general contractor. or homeowner (circle one) and have hired the cnntme-m c Iicreri helms• ul A tin.. city phone k insurance co.. nelicv N comoanv name: Failure to secure coverage as required underSeetioo 25A of MGL IS2 ao lead to the imposition of crimioal penalties of a floe ap.to SI400A0 and/or one vean' imprisonment as well is' ivil penaides in the form of a STOP WORK ORDER and a floe ofS100.00 a day -against me. I oaderstaod'that a copy of this statement may be forwarded to the Once of Investigations of the DIA for_eovenge verinadoa. I do hereby cerdfj=eai�ns e !ties of petyury that the information provided above is fmc and eorrem SignatureyTl�— ate Print name \ l aV-%.- M rooff - F� oRcial use only do not w rite in this area to be completed by city or town.offlelal city or town: YARMODT$ _ permit/license 0 nBuilding Department cheek if immediate response is required ❑Llcensiag Board 2pSciectmen's Office contact person: phone p; ex Health Department _ C508) 398�2231 eat. n0ther. V ,-AtQI- D. CERTIFICATE OF LIABILITY INSURANCE 07iii2o s PRODUCER (508) 790-1919 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE SandpiperIns. Agency, Inc. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 12 Enterprise Road ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Hyannis MA 02601- INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER&First Financial Insurance Filho, Antonio DBA BR ROOFING INSURER O: PO BOX 1231 INSURER C: 136 Stevens st INSURERD Hyannis MA 02601— INSURERS r•.nuFRnr,Pe . THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR ADO'L INSRD TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE(MM/DDrYY) POLICY EXPIRATION DATE(MM/DO/YV) LIMITS A GENERAL LIABILITY / / / / EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES (Ea occurrence) $ 100,000 X COMMERCIAL GENERAL LIABILITY MED EXP(Any one person) S 5,000 CLAIMS MADE OCCUR 491FOO2639 06/21/2005 06/21/2006 PERSONAL B ADV INJURY S 1,000,000 GENERAL AGGREGATE S 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 RO- POLICY JPECT LOC AUTOMOBILE LIABILITY / / / / COMBINED SINGLE LIMIT (Ea accident) $ ANY AUTO BODILY INJURY (Per person) S ALL OVMIEO ALTOS / / / / SCHEDULED AUTOS BODILY INJURY (Per accident $ HIRED AUTOS / / / / NON-OVYNED AUTOS PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT S OTHER THAN EA ACC $ ANY ALTO / / / / S AUTO ONLY: AGG EXCESSIUMBRELL_ A LIABILITY / / / / EACH OCCURRENCE S AGGREGATE' S OCCUR CLAIMS MADE S S DEDUCTIBLE / / / / S ' 1 RETENTION $ WORKERS COMPENSATION AND / / / / TORY LIMITS ER E.L. EACH ACCIDENT S EMPLOYERS LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE EL DISEASE - EA EMPLO S OFFICERIMEMBER EXCLUDED? / / / / E.L DISEASE- POUCY LIMIT S If yes, describe under SPECIAL PROVISIONS below OTHER DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLESIEXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS SIDING AND ROOFING. CERTIFICATE HOLDER CANCELLATION ( ) - (508) 778-5603 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT GATEWOOD HOMES FAILURE TO DO SO SHALL IMPO 0 OBLIGATION OR LIABILITY OF ANY KIND UPON THE 1600 FALMOUTH RD SUITE 25 INSURER, ITS AGENTS OR REP SENTATIVES. AUTHORIZED REPRESENTATNO I ) CENTERVILLE ACORD 25 (2001108) ,� INS025 (ofos)m MA 02632- ELECTRONIC LASER FORMS, INC. - © ACORD CORPORATION 1981 Page t of'. MASSACHUSETTS ASSIGNED RISK POOL REQUEST FOR CERTIFICATE OF INSURANCE ��a this form to request a Certificate of Insurance from an Assigned Risk Pool Carrier. ' Please provide all of the requested information, including the facsimile nurri= s) of the person or persons to whom th.e Certificate of Insurance° should be issued. If this form is fully and accure,zi!j ecimpl :ted, the Certificate of Insurance ,vi)l be issued and distributed by facsimile to each fax number provided below, witfiv s bvo (2) business days of the car:.. ?s receict. This Form may be mailed or faxed to the Assigned Risk Pool Carrier. To obtain each carrier's contact information refer to the Certificates of Insurance section located in the Producer Comrr,rnhy section of the Bureau's web.;f;e (vm w. wr?ibme.ora). 1: Name, address, tel phone number and facsimil .number of the 1NSURE1Qi:y� Name: -- �/0 , L f ►\ k60F1,r7 Mailino Address: Physic?! Address: — Pho �. _— --_ Fax: —' 2. ame, adaress, telephone number and acsimile number of the CERTIFICATE HOLDER: Name: �25? Mailing Address:/ —`— --- Physical Address:— —3�- Phone: Fax: 3. Name, address, contact person, telephone number and facsimile number of the PRODUCER: Name: card r Tnsurance Aaericwy Inc. Mailing Address: 12 Enterprise Road Hyannis, MA 02601 Contact Person: Cb.= s or Andrea _ Phone: 508-790-1919 _ Fax: 508-790-3560 4. Policy Number, Policy Effective Date and Policy Expiration Date If a Certificate of Insurance is needed for more than one policy term, provide the`Policy Number, Effective Date and Expiration Date for each policy term. If the policy has not yet been issued, you must attach a copy of the Notice of Assignment. Policy Number: 15 Effective Date: = ; U Expiration Date: —� 5. List any special requests for optional coverages I endorsements (see Page 2 for listing of coverages available in the pool and the conditions of availability) or additional information (including changes in exposure not yet reported to the carrier) that will assist the carrier in the issuance of the Certificate of Insurance. NOTE: An additional insured(s) shall not be listed on any Certificate of Insurance unless such additional insured(s) is a named insured on the policy. Page: 002.003 )ate: 5/5/2005 Time: 3:02 PM To: ® 15087785603 r Ctientr 24359 D ATE. F LIABU _.�. DATyE.�(MM�/DD(YYYYI I'ACO CJLRTIFI a� ` 7 i INSURAN�� PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION The FeZelbergComparty AND GERTMQATEDOEERS NO SSNOTAMEN 222 Milliken Blvd. HOLD Rz HISY 09ENOAR- ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P.O. Box 3220 Fail River, MA 02722 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A: Acadia Insurance Companies Cape Cod Ready.ldiX Inc. INSURER B: Construction Industries Compensation � Po Box 3� ' INSURER C: Orleans, MA 02653 INSURER0: INSURER E: THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMEDABOVE FOR THE POLICY PERIOD INDICATED. NOTWJTH5TANDINC-- ANY REQUIREMENT, TERM OR CONDITION OFANY CONTRACTOR -OTHER DOCUMENT -WITH RESPECTTO WHICH THIS CERTIFICATE MAY BE-ISSUEUOR- MAY PERTAIN, THE INSURANCE AFFORDED BYTHE POLICIES DESCRIBED HEREIN IS SUBJECTTO ALLTHETERMS, EXCLUSIONS AND CONDITIONS OF SUCH POUCIES. AGGREGATE UMITS SHOWN MAY HAVE BEEN RECUCEQ6Y PAM) CLAIMS, - TR NSPIATYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DDI"A POLICYEXPIRATION LIMITS A GENERAL LABILITY CPA0132468t0- 0t/0tf05r. 01im/m EACHOCCURRENC $1000000 X COMMEROALGENERAL LIABILITY QAJMS MADE Q OCQJR DAMAGE TODENTED S100000 VEO EXP Am me pffmn) S5 000 PERSONAL S AOV IN-L'RY Si D00 000 GENERAL AGGREGATE S2 0011000 .. - GEN-L AGGREGATE LIMIT APPJES PER ?CUCY � LOCI - COMPjOP AGG s2,000,000 —PRODUCTS A - 4UTOMOBILELL4BIUTY .ANY AUTO MAA013246$10 01/01/05 01101/06 COMBINED SINGLE LIMIT (EaacdoM) �y�O((yy�� SI'D �y(��,D09 - ALL OWNED AUTOS SCHEDULED AUTOS 9CAILYIN:ILIFN Ps Pe�smJ S X HIRED AUTCl X - NCNL+NNED AUTC6 � BCDILYdm) Pe: araognJ S X rROPERTYDAMAGE pa aafdalp S GARAGE UABILRY AUTO ONLY• EA ACCIDENT S OTHER THAN FA ACC S ANYAUTO -�� - S AUTO ONLY: AGG A . EXCESSNMSRELLALIAM TIY X CCCUR CLAMS MADE CUA0132470JO 01/01/OS 0_1/01/06 EACH OCCURRENCE F1 000000 AGGREGATE S S i DEDUCTIBLE - S X RETENTION so B WORKERS COMPENSATION AND EMPLOYERS LL4BtL1�'- WCi0009255 01/01/n5 O1j01J06 X-STAir• OTH• Fq - EL. EACHACCIOENT a500ow ANYPROPRIETCRJPARTNEPIEXECUTNE OFFICER(MEMBER EXCLUCED? If yew 0.�sai6a ands E1. OISEA c EA EMPLOYE $500 000 El.OSEASE PCUCYUMIT 550000II SPEOAL PROVISIONC bef�- OTHER DESCRIPTION OF OPERATIONS l LOCATIONS (VEHICLES tEXCLUSIONS ADDED-ErENDORSEMENr7 SPEMI, PROVISIONS Gatewood Homes Inc. 1600 Falmouth Road Suite 25 Centerville, MA 02632 SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF; THE ISSUING INSURER WILL ENDEAVOR TO MAIL M DAYS WRRFEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FALURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER; ITS AGENTS OR -••--: , ., c »aoc�lnlooazo AH1' 0 ACORD CORPORATION 1988 b5/bb/2005 09:38 5084204474 EDWARD A GRAZUL PAGE 02 V r _ ontEtMM+D ,ACf�RD,4 CERTIFICATE OF LIABtUrf ttUSURANCE. � THIS CERTIFICATE 15 ISSUED AS A MATTER or- INFORMAT PRODUCER ONLY AND .CONFERS NO RIGHTS UPON THE CERTIFICi d A. (aaa11.ITl t¢7110E OYT Z HOLDER. THIS CERTIFfCATE'DOES NOT AMEND; EXTEND - ALTER THE-COVE,RAGE-AFFORDED :BY THE POLICIES. HELI P:(� � 331 t hfwstcns Pfllis, MA C12W INsuaer s AFFOROINO COVF I NAIL A' --- —• —. !Na,Rc-�,...�laxd-CaAaLtY.irs-- � — 11 1N6URED eJSUflEP 9'- wte�t Qulds 145 Caml`tt Pi MaE'stO�s �'hi?s, q4 62648 OVERAGES THE POtICIE5 pF.INn ANCE LISTED.BELOW.HAVESEEN 15 MAAY PERTAIN, MHE iNSU ANCE.AO NorTION OF ANY CONTr MF ORDED BY E POLWA POLICIES. AGGREGATEL1MtTS SHOWN MAY HAVE BEEN PEE Adb' $31)j8f) POLICY N G--EMERALL)A9111" .... a MMERCIALGENERALLIASILITY CWM9 uAO^eOCGUR .. I 1 Al. n n: _f:sFAd?E LB.iR AP?L!E5 PEP.' ^X^'-- AUTOMOBILE LABILITY ANYAUTO I I ALL OWNED AUTOS [--r eCHFOUIED AUTOS HIRED AUTOS NON-MVNECAUT04 GARAOELIA6ILITY ANY AUTO I E7ILES3dMG RELL(A" LIIAA0"JTY MV_Wr .. 1_ OIAI S MADE I DEDUCTim RETENTION S WORKERSCOMPENSATIONAND . EMPLOYERS•LIASIIJTV ANY PRGPRIE:OWPARTNETLE%ECtDNE CF.FICEWMEMBER 5XCLUOED7 eVro, MurtEn YAEe1 SPEOtAI PROVI61oN3yNa.. I OTHER OESCRI►MON OF OPERATIONS C,2te" 9R c.V -1't es,iTr. Cf9 pa1L'Z'aecCst-bu - Rte 28- yI��T cert-, s Me, IM 1:2632 Fes':. 1-508-778-3-6l3 INSUHERC.. _ _ I _ •. INGJRL-RQ7 - - '— EUREAE. TO THE rNSURED NP.PAED ABOVE FOR THE POLICY PERIOD 11110!CATED. NOTWITHSTANDING 'R OTHER CCCUMENT WITH A£SFECT'To WHtCH'THIS CEfKjF4CATE :MAX -BE ISa^UED-OM CRtSEDMEREIN IS SUBJECT TO ALL THE MRMS, EXCLUSIONS .AND CONOYTICNS Of SUCH BY PAID CLAIMS.VAT IM - — POLH:Y EFFECTIVE POLICVEXIXHATION '- LiMiT9 ryryyy�� (ryVyy�� EACH OCCURRENCE 3 -nx-V5e1 GENEBAEAGGREOATE PRoouCTs'-OOMFOPAQIi OON8INED SINDI.F LIMIT CO Acdduol) .. � — BODILY INJURY E (PwwIw11)' "QDIIY INJURY GO YGbG PROPERTYI>ALWOE' . (Px eccldem) S AIITDONLY-SAACODENT S _—,___..... EAACC I S -� 'AGGREGATE PnagrAru _TORY LIFiI- E.L fACN AMDENT OtSEASE-EA EMF BY ENDORSEM-ENT/ 6TEC:AL�stOYISRTR3" ' " S' :ANCMLA-Tlvrc.. . 6HDULD ANY OF THE ABOVEIIEBCRIBED POLICIES BE q^NC£LLED BEFORE THE f.XVMATION DATE THEREOF: THE ISBWOO-INSURER WILL. ENBEAVOR TO MAIL ^DAYS WRITTEN M==. TO -THE OERSIFKATE HOLDER NAMWO TO THE LEFT, OUT FAIL'JR_ TO DO EQ SHALL WPOSE NO-06LIGAMON-02-UABLLffY. OF. ANY. KIND UPON THE INSDRM RYAGEW"* REPR"ENTATNES. 1UTKOW5iD P.EPRErENTATIvVE - CERTIFICATE OF INSURANCE105/06/2005 , THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND PRODUCER CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE Harold H Williams Ins A;cy Inc DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 81 Bassett Lane COMPANIES AFFORDING COVERAGE Hyannis, MA 02601 INSURED Stephen M Childs COMPANY A.I.K. Mutual Insurance Co A 145 Cammett Road LETTER Marstbns Mills, MA 02648 I :OVERAGES THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECTTO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. TR' TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE(MM/DDIYY) POLICY EXPIRATIO DATE(MM/DD/YY) LIMITS ,GENERAL LIABILITY - GENERAL AGGREGATE S PRODUCTS-COMP/OP AGG. I S COMMERCIAL GENERAL LIABILITY PERSONAL & ADV. INJURY S CLAIMS MADEE::IoCCUR EACH OCCURRENCE S OWNER'S & CONTRACTOR'S PROT. DAMAGE (Any one tire) f iFIRE MED. EXPENSE (Any one person) S !AvrOWLOBILE LIABILITY COMBINEDSINGLE I i S LIMIT j-�ANY AUTO ALL OWNED AUTOS BODILY INJURY S (Per person) SCHEDULED AUTOS (BODILY INJURY ! f HIREDAUTOS NON -OWNED AUTOS (Per xciJen) (PROPERTY DAMAGE I i S �1 GARAGE LIABILITY �IiXCE55 LIABILITY- �EACH OCCURRENCE S AGGREGATE S ----1U-{ MBRFLLA FORM I i p'I'NL'R THAN UMBRELLA FORM WC HER A TORYIT - I4INORRER'S COMPENSATION AND 9dMPLOYERS' LIABILITY X LIMITS EL EACH ACCIDENT I S 100,000 I A �t 7015793012004 12/13/2004 12/13/2005 EL DISEASE —POLICY LIMIT S 500.000 THE PROPRIETOR/ I I INCL IEL DISEASE—UChI EMPLOYEE f 100,000 PARTNERS/EXECUTIVE —jl I OFFICERS .ARE: X EXCL 'OTILER 1 I I ❑hSCltIMION OF 01'IiILATIONS/LOCATIONS/VEIUCLES/SPECIAL ITEMS CERTIFICATE HOLDER CANCELLATION SHOULD .ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO Gatewood I-Iomes MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR 3c11 Tower Mall Rte 8 LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Centerville, MA 02632 ta0RD CERTIFICATE OF LIABILITY INSURANCE OP ID K DATE6DO/YY ,4 CROWC50 0/06/O5 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OFINFORMATION Sullivan, Garrity & Donnelly ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 508-754-1767 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 10 Institute Rd - PO Box 15010 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Worcester MA 01615-0010 Phone:508-754-1767 Fax:508-754-1885 INSURERS AFFORDING COVERAGE NAIC# INSURED - INSURER A. ALEA NORTH AMERICA INS CO INSURERS: Hanover Insurance CO 22292. Crowell Construction, Inc. INSURER C: PO Box 309 INSURER D: So. Dennis MA 02660 INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR INSR B TYPE OF INSURANCE GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS MADE F K OCCUR POLICY NUMBER ZHN700714102 - DATE (MMIDD/YY) 05/01/05 DATE (MM/DDIYY 05/01/06 LIMIT$ EACH OCCURRENCE $ 1,000,000 PREMISES (Ea occurence) $100,000 MED EXP'(Anyone Person) $ 5,000 PERSONAL B ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 PRODUCTS-COMP/OP AGG $2,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: POLICY PROJECT F7 LOC B AUTOMOBILE UABIUTY ANY AUTO ALL OWNED AUTOS SCHEDULEDAUTOS HIREDAUTOS - NON -OWNED AUTOS AFN7001142-02 05/01/05 - 05/01/06 COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $1,000,000 X BODILY INJURY (Per accident) $ 1,000,000 X X PROPERTYDAMAGE (Per accident) $500,000 GARAGE LIABILITY ANY AUTO 1 AUTO ONLY - EA ACCIDENT S OTHER THAN EA ACC AUTO ONLY: AGG $ $ EXCESSIUMBRELLA LIABILITY OCCUR CLAIMS MADE DEDUCTIBLE RETENTION $ EACH OCCURRENCE $ AGGREGATE $ $ $ A WORKERS COMPENSATION AND LIABIUTY EMPLOYERS' ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? If yes, describe under SPECIAL PROVISIONS below WC1049858 03/22/05 03/22/06 TORY LIMITS X ER E.LEACHACCIDENT $500,000 E.L DISEASE -EA EMPLOYEE $500,000 E.L. DISEASE -POLICY LIMIT $500,000 B OTHER Property Section DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS Subject to policy forms, conditions and exclusions. Gatewood Homes 1600 Falmouth Road Suite 25 Centerville MA 02632 25 (20011081 GATEWOO SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER ITS AGENTS OR TION JUI 16 '05 04:03PM SANDPIPER INS Vt. "-0.80. CERTIFICATE OF LIABILITY INSURANCE ]MIA CERTIFICATE IS ISSUED AS A 1PRoouceR (508y ?90-1919 ONLY AND CONFERS NO RIGHTS Sandpiper Ina, Agency, Inc. HOLDER. THIB CERTIFICATE DOES 22 Enterprise Road ALTER THE COVERAGE AFFORDED 8 M 02601- INSURED Gualberto, Paulo L.. 21 Quippish Rd 026 Pf111LDAlafC P. 1/2 DATE (MMIOO/YYYY) THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMEDADOVE FUR Trtc rVU%,T rZMIW INWI r Ic>r. ATV I rr.,r .M...,,....•. OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN. REQUIREMENT. TERM OR CONDITION OF ANY CONTRACTOR THE INSURANCE AFFORDED SY THE POLICIES OESCRISED HEREIN. 13. SUBJECT TO ALL THE TERMS.. EXCLUSIONS AI40 CONDITIONS_ OFSUCH -POLICIES- AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD'L POLICY EFFECTIVE POLIC2 EJ(P TION TYPE OP INSURANCE POLICYNUMBER DATE MMID DATP M.MJ ON LIMITS. B NAp 1000DOD / EACHOC URRENCE s ,, A GENERAL LIABILITY OAMAPE TO RENTPD 300 QQQ s � PREM13E9 E�.x^vmnec X COMMERCIALOENERALLIADILITY 10,000 SM427793rS - 11/20/2e06'Yl/YIII2005 MEOEXP fAry a"VMW S OLAIWMADE OCCUR PERSONA S AVV INJURY S 1,000,000 08NE.RALAOORMAT' c 2,000,000 GEM;, AGOREOATE LIMO APPLIES PER: I PRODUCTS -COMPIOP AGG Is 2,000,000 POLICY ED ME Lee AUTOMODILELIABILITY / / / / GOWNED SWGLE LIMB 5 LEA xcidentl. ANYAUTO / / I I ALL OWNED AUTOS BODILY INJURY (Far pm=) s SCHEDULEDAUTOS BODILY INJURY 5 HIRED AUTOS I I I I (PN ateEenO NON -OWNED AUTOS PROPERTY CAMAGE (For=16"0 AUTO ONLY• EA ACCIDENT- _ OTHER THAN EA ACC s 9URAGEL"!UTY I ANY AUTO - - 3 AUTO ONLY; A30 QnFIRI IMBRIPI A LIABILITY I / / / EACH CCCLRRNCE ('3 AG(3P.ETIATE s OCCLIN CLAIMS MADE S DEDUCTIOLE 's RETENTION I WORXERSCOMPENSATIONAND-"- E.L. EACH ACCIDENT S EMPLOYERS LIABILITY ANY PROPRIETOIUPARTNPJUGXGCUTIVi E.L DISEASE - EA EMPLOYE s OFFICERIMIEMPER EXCLUDED? / / / I E.L. DISEASE • POLICY LIMIT s M Yet. "BaAe undtr SPECIAL PROVISIONS L.m OTHER DEe'CRIPTICN OF OPMATIONWLOCATIONSN-LHICLEZ(CXCLU&ONd ADDED BY ENDORSEMENTISPECIAL PROVSIONS Tar E':OR A=L SXT=CR DAI:T'PjNr' GATEWCOD NO= 1600 7Az UTH rp oui-TE 25 SHOULD ANY OF THE ABOVE OESCRISEO POUCISd BE CANCELLED BEFORE THIS EXPIRATION DATE THEREOF, THE ISSUING IINSURER WILL • ENDEAVOR TO MAIL pJ 10 DAYS WRITTEN NOTICE TO THE CErFyri HOLDER NAMED TO THE LEFT. BUT FAILURE TO 00 50 SHALL IMPOSE NO 00fiOA719N OR LIABILITY OF ANY KIND UPON THE DRO 2912001108) "�' 0 ACORD CORQOK A IION TPSi • INS02S "0108).05 ELECTRONIC LASER FORV& INC. - (6=3]7-0115 i Pave i a1- ►I CERTIFtATE ©F INSURANCE DATE os peooucER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE SANDPIPER INS AGCY INC HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 12 ENTERPRISE ROAD ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. COMPANIES AFFORDING COVERAGE HYANNIS MA 02601 COMPANY 276CN A HARTFORD UNDERWRITERS INSURANCE COMPANY INSURED COMPANY GUALBERTO, PAULO L. B - COMPANY 20 FERN BROOK LANE CENTERVILLE MA 02632 C COMPANY D COVERAGES .. ;i „ .......... . THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO L TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE (MMVJD\YY) POLICY EXPIRATION DATE (MMADD\YY) LIMITS GENERAL LIABILITY GENERAL AGGREGATE S PRODUCTS-COMP/OP AGO. S COMMERCIAL GENERAL UABIUTY PERSONAL & ADV. INJURY S CLAIMS MADE F1 OCCUR. EACH OCCURRENCE S OWNER'S & CONTRACTORS PROT. FIRE DAMAGE (Any one fire) S - MED. EXPENSE (Any one person) S AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE OMIT S . BODILY INJURY (Per Person) $ ALL OWNED AUTOS SCHEDULED AUTOS - BODILY INJURY (Per Accident) S HIRED AUTOS NON -OWNED AUTOS PROPERTY DAMAGE S GARAGE LIABILITY AUTO ONLY - EA ACCIDENT S OTHER THAN AUTO ONLY: ANY AUTO EACH ACCIDENT S AGGREGATE S EXCESS LIABILITY EACH OCCURRENCE S AGGREGATE S UMBRELLA FORM OTHER THAN UMBRELLA FORM - A WORKER'S COMPENSATION AND EMPLOYER'S LIABILITY I i UB-0243648-0-04) 1 1-22-04 1 1-22-OS STATUTORY LIMITS .................................... EACH ACCDENT S 100,000 THE PARTNE SIEXE U r� INCL PARTNERS/EXECUTVE DISEASE— UMIT S SOO 000 DISEASE —EACH EMPLOYEE S 100,000 OFFICERS ARE: - X I EXCL OTHER DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/RESTRICTIONS/SPECIAL ITEMS THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AFFECTING WORKERS COMP COVERAGE. CERTIFICATE HOLDER:::':,:: " CAN C>:LLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL GATEWOOD HOMES - 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE 1600 FALMOUTH RD SUITE 25 CENTERVINE MA 02632 LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE .. 'i1CORD 25=5 {3/93): - - .. .. AA II �1/, t4AC PORATION 7993: Aug-02-05 01:25P P.02 ACORD - CE i.IFICAT-OPL.ABILIl Y MURANC 081QzfliOQfi .... PRDOUCER • Sena) 8 Al530 - SIX13Y INSURANCE AGENCY, IN:. P.O. SOX 8=-861 PUTNAM PIKI' GREENVILLE. RI 02M THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONVf -A*D- CONFERS- NO RIGHTS UPON THE CERTIFICATE " HOLDER. THIS CERTIFICATE DOES NOT AMEND. EXTEND' OR . ALTER THE COVERAGE 'AFFORDED BY THE POLICIES BELOW. INSURERS AFFCRDING COVERAGE NAK:# INSURED HOLMES AND MCGRATH, IN" 362 GIFFORD STREET FALMOUTH. MA 02540 1YSUN:R A_ MATT FIRE INSORANC£CO. OFHARTFORD. INSURER W VALLEY FORGE INSURANCE CO. r16LRER'C. CCKTNENTAt INSURANCE CO. 11491RER0- sF COVERAGES THEPO.L ICIES OF. MSLIRAMCE LISTED BELOW 1 AVEBEFN LSSI&D.IQ THE.*4SUF&D.NAMEDABOVEFQR TW-POUCY PERIOD INDICATED. N(7rMTHSTAN0040 ANY REQUIREAEMT, TERM OR CONDITION OF 1NY CONTRACT OROTHE'it DOCUI:ENI NATM RESPECT TOL VAi CH.THM CERTIFICATE MAY BE MSUf_)-OR _ WAY PERTAK THE INSURANCE AFFORDED BY I}E POLICIES DESCRIBED /EVEN ISSUB,ECT TO ALL 17 E TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN WAY W dE BEEN REMXED 13Y PM CLAM. sees Ao TYPE CUP MSUMNCE POLICY 11DSIBEif F 7 E>miLOM LIMITS A GENERAL UABILITY X COMMERCIAL GENERAL LIABILITY cLAIMs MAm QX OCCUR 10. 4082434 7om6/D4 10AXV05 EACH OCCURRENCE S DD0.000 AMAG O RENT® ,j FIRE 250',k Lev Elw en. sen s 10 000 PERSMALSADVMLILRY S 1.000.00D. GENERAL AGGREGATE S 2,000,000 GENL AGGREGATE UMIT APPLIES PER POLICY PRO LOC PRODUCTS - COMPIOP AGO f 2 0=000" AUTOMOBILE LIABILITY ANY AUTO ALI-uvNSD AUTOS SCHEDMEDAUTOS HIRED AUTOS NON OVVNED AUTOS - CTDSING:E CRATC ecciaen0 s BODILY INIURY FeeOeoloni f BCXALY riRJRY (Par occberml S. PROPERTY ONdAGE S GARAGE LIABILITY ANYAUTO AUTO ONLY. PA ACCIDENT S OTlER THAN EA ACC AUTO ONLY* AGG 5' S EXCE5&AJM6RELLkt"UT'F OCCUR QCLAIIAS MADE DEDUCTIBLE RETENTION f EAC"OCCLA%RRdLr S AGGREGATE S. i f f B WORKERS COMPENSATICU AND EMPLOYERS LIAS&ITv ANY PROPR1ETORPARTNERIEXECUCNE OFFOEMMEMBER EXCLUDED? Cya s� describe under SMALPI#OV69ONSbmcr 2a 7445273- .... 09/641134 .. ... 09/DtiDr.T' x V! FLW OTT4 EL ESC`JL ACCIDENT f t QQQCDO'- EL DISEASE - EA EMPLOYEE f 1,000 000 ELDeSEASE-Pctcy w ... 1000000- C OTHER PROFESSIONAL UAA8ILITY AEA 0043133 38_ . 71t31M. - 07113A6 t,000=PERCLAW. AGGRETGATE- OEnGRIPTION OF OPEMTION&II OCATgILLVENCIFSIE) =USIONS AOOW BY F.NOORSOOEICTRPECIAL PAWISIOME AGGREGATE UWS ARE PER THE TER 1AS AND CONDMID S.OF THE POU61ES. CERTIFICATE HOLDER CANCEL L ANKM GATEWOOD HOMES' '1600 FALMOUTH RD., STE.: S CENTERVILLE, MA 02632 SHOULD ANY OF THE ABOVE OESMBEO POLICIES BE CANCELLEO BEFORETHE EXPIRATION DATE THEREOF. THE Mamm INSURER WILL ENCJEAVOR TO sM1L p11Y5 VVRTCTEN WI C£TaT:ECIIRF104TE'HO[DEHNAlAEBTO THE LEFT. ROTL IpLURE moo50 SFBtII IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE rISURER, CIS AGENTS OR REPRES044TWES. ATNE ACORD25 (200V08) - r I ® ACORO CORPORATION 1888 C-1FhPRO10ERTPROS FP5 ACORD- CERTIFICATE OF-L"ILITX MISU-R/RI�10E DATE IMM ODM TTT a �. r� i?/Vas... PRODUCER THB CE nFICATEISISSLEDASA MATTER OFMRMATION United Insurance Agency -,--Ina. 199 Main Street P.O. Box 1013 C$LYANB-CONFERS-NORrAH UPONTHECEftiFICATE-.. . HOLDI tTHISCERTIACATEDOESNOFA6lE?JF},ExTezoR ALTER THE COV ERAGEAFFORDED BY THE POLICES 88.OW. Buzzards Hay, iA 02532 INSURERS AFFORDING COVERAGE NAIC M IN&I1RM Patton Electric, Inc. 128 Scituato Road. Mashpao, MA 02649 INSURER -A: Zurtcli'NA INSURER& Commarao Insurance Co. INSURERc:-Li Mutual -Ins. Co. INSURER 0: TMRMT- . X THE-POUCLES OF INSURANCE LISTED. BELOW.HAVEBEEN.ISSUED. TO.THEINSURED. NAMED AWYEFOR, THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUEO OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIaEO HEREIN IS SUBJECT TO ALL THE TEAMS. E%CLUSIONS AND CONDITIONS OR SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INaR AD POLUCYNUMeER POUCYEFFEQUWDATFIMUMOffn- POLICY pwrIF]LP ON RIM?? GENERAL UAIMUTY EACHOCCURRENCE I 1000 1 000 A COMMERCIAL GENERALUADILITY CLAMS MADE Q OCCUA $CP42415a9-9- 7/30/05 7/30/06 P.EMr3Es r & 300,0aa 3 10,000 MEO EXP(A EAe ew PERSONAL& ADV NuuRY f 1, 000,40M GENERAL AGGREGATE 3 2,000.000 OWL AGGPACG TE LIMIT APPLES PER: $ POLICY PE LOC PRODUCTS.COMP/OPAGG 3 2- QQQ tOQQ AUTCMOBILE LIARIL" ANY AUTO COMDWED SMIOLE UNIM (E& KGdNM) f B ALL OV.NED AUTOS SCHEDULED AUTOS YW9338 1013/04 10/3/05 Rnnn Y INJURY 1 `P°f') t I00,0a0" HIRED AUTOS NON-OKNEDAUTOS (a=e1�RY } 30d,000' PROPERTYOAMAGE (Per =IdenA i l0a,aoa -T 6ARA;l CUIHRJTY AUTO ONLY -EA ACCIDENT. S - OTHER THAN EAACC AUTO ONLY; AGG S ANY AUTO l EYCESNUMERELLALOSILITY POCCUR CWMSMADE FACHOCCURAENCE 3 AGGREGATE S S OEDUCTIHLE S RETENTION 3 } WORHEIISCOMPe12ATION AND NC 3TATU- OTH- C n"0.OYDIS'LLMLJTY ANV PR OMIETORUPAR TNER/D(ECUTNE r03y17,FFIrICFAIMEMBER EXCLUDED? X PR�OV19CPtS WC231S353049018 .. 12/10/a4 I2(I0I05 E.LE,cHAccroENT 3 100 t140 E.L DISEASE - EA EMPLOYEE & 500.000 El DI3EASE-POLICY LIMIT f 1Q0000 SPf(7ld Gew OTTER D RGCRIPTIONOFOPERATONS,LOCATR)NSUVPMCLE3TEXCtUSNNSADDEDETE71QQt3EMENT1SpECML PRCyISfpNS... . X1actriaal J Gate"Cod R0X2Q6 SHOULD ANY OF THE ASOVE DESCRIOW POUCIESHE CANCELLED BEFORE THE EXPIRATION Fax No. (508) 778-5603 AATEYNSUME. THEISSUIIL0]NmURERYY ILL EN DEA%AMTO MAIL . 10 OAYSWRITTEN 1600 Falmouth Road NOTIC ETO THE CERTIFICATEHOLOER NAMED TOTH ELEFr. EOTMURETSSOWSNALL } Suite 25 IMPOSENO 011LIOATION OR LIABILITY Of ANY RIND UPON THE INSURER.1i6 AGENTS OR C*ntavilla, Ma 02632 RFP*ESFWrWWM 1'988 r' tl ATE D(MMIDDIM ;. , ; ACORD ;CERTIFICATE OF LIABILITY tl(NSURAIVCE , ..a 9 15/04 � . _- £._ _a_. ..z_.� - • a THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION P PRODUCER ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Chatfield, Whitman & Young HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 549 Washington Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P.O. Box 850963 COMPANIES AFFORDING COVERAGE Braintree, MA 02185-096 COMPANY A Harleysville Worcester Ins Cc INSURED COMPANY Lawrence Robinson Masonry B 5 Fresh Hole Road Hyannis, MA 02601 COMPANY C COMPANY D .axcY t.l .n-..e...w�eu. luab.•J`..4h-v._imve...ir...NrAanv�.uKn vcsr+li_.Yvva.vvw.i.�.YnrL4+a.dLa...vn...9vu u'c B.n-�ssm_... S.nKivr.as✓t '-�r».kGs.wzr.i. THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO LTR TYPE OF INSURANCE POLICYNUMBER POLICY EFFECTIVE DATE(MMIDDIW) POLICY EXPIRATION DATE(MMIDDIYY) LIMITS A GENERALL COMM ERCIAL GENERAL LIABILITY OWNEIABILITY C LAMS MADE a OCCUR R'S & CONTRACTOR'S PROT CB 7E 32 32 9/07/04 9/07/05 GENERAL AGGREGATE $ 2,000,000 PRODUCTS-COMP/OP AGG $ 2,000,000 PERSONAL & ADV INJURY $ 1,000,000 EACH OCCURRENCE $ 1,000,000 FIRE DAMAGE (Any one fire) $ 100,000 MED EXP (Any one person) $ 5,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO ALL OWNED AUTOS BODILY INJURY (Per person) $ SCHEDULED AUTOS - HIRED AUTOS BODILY INJURY (Per accident) $ NON -OWNED AUTOS PROPERTYDAMAGE $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN AUTO ONLY: ANY AUTO ' EACHACCIDENT $ AGGREGATE $ EXCESS LIABILITY EACH OCCURRENCE 1 $ AGGREGATE $ UMBRELLAFORM WC SIATU- OTH- TORY LIMITS ER Is -- - - - OTHER THAN UMBRELLA FORM WORKERS COMPENSATION AND EL EACH ACCIDENT $ EMPLOYERS' LIABILITY EL DISEASE -POUCY LIMIT $ THE PROPRIETOR! INCL PARTNERVEXECUTIVE OFFICERS ARE: EXCL i EL DISEASE - EA EMPLOYEE $ OTHER DESCRIPTION OF OPERATIONSILOCATIONSIVEHICLES/SPECIAL ITEMS ,OLDER CERTIFICATEH,, �. - CA_NGELLATION_ SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE Gatewood Homes EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 1600 Falmouth Road 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, Suite 25 BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABI1U Centerville, MA 02632 OF ANY KIND UPON THE COMPANY ENTS SENTA S. AUTHORIZED REPRESENTATIVE Robert E. Chatfield 1 aACDRQCORPORATnu-1988^ r ACORDTarCERTIFICATE OF LIABILITY INSURANCE Ro 6 09-27-2004 PRODUCER THIS CERTIFICATE IS ISSUED AS A.MATTER OF INFORMATION PAYCHEX AGENCY INC. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 210706 P: (877)287-1312 F: (877)287-1315 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 308 FARMINGTON AVE FARMINGTON CT 06032 INSURERS AFFORDING COVERAGE INSURED - INSURERA:TWD-n Citv Fire Ins Co LAWRENCE ROBINSON MASONRY INC 5 FRESH HOLE ROAD V V V CIIAUCJ C: THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. /NSR LTR TYPE OF INSURANCE POLICY NUMBER POLICYEFFECTN£ DATE MM/DD Y POLICY EXPIRATION DATE 1MMVZVYY1 I LIMITS GENERAL LIABILITY EACH OCCURRENCE ! FIRE DAMAGE (Any one fire) 3 COMMERCIAL GENERAL LIABILITY CLAIMS MADE OCCUR - MED EXP (Any one person) $ PERSONAL& ADV INJURY $ GENERAL AGGREGATE 3 _ GEN'L AGGREGATE LIMIT APPLIES PER: POLICY 71 PRO- LOC PRODUCTS - COMP/OP AGG ! AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT (Ea accident) S - ALL OWNED AUTOS SCHEDULED -AUTOS " .I: BODILY INJURY (Per person) S ` HIRED AUTOS NON -OWNED AUTOS 'f BODILY INJURY -(Per accident) $ PROPERTY DAMAGES (Per accident) - - - GARAGE LIABILITY AUTO ONLY - EA ACCIDENT 9 ANY AUTO OTHER THAN EA ACC 4 S AUTO ONLY: AGG EXCESS LIAB/CITY I EACH OCCURRENCE 9 AGGREGATE 4 OCCUR CLAIMS MADE $ DEDUCTIBLE S RETENTION S WORKERS COMPENSATIONAND X I WC STATU- OTH- A EMPLOYERS'C/ABRITY 76 WEG NQ5620 09/06/04 09/06/051 E.L. EACH ACCIDENT $100 000 E.L. DISEASE - EA EMPLOYEE $10 0 , 0 0 0 - E.L. DISEASE - POLICY UMIT s500, 000 OTHER I DESCRIPTION OF OPERA TIONS/LOCATIONSIVEMCLESIEXCLUSIONS ADDED BY ENDORSEMENT/SPECUL PROVISIONS Those usual to the Insured's Operations. GATEWOOD HOMES 1600 FALMOUTH ROAD, SUITE 25 CENTREVILLE MA 02632 DULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE 'IRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL DAYS WRITTEN NOTICE 00 DAYS FOR NON-PAYMENT) TO THE CERTIFICATE LDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO JGATION.OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR �Vnu 40-J 1//S/I 0 ACORD CORPORATION 1988 12/02/04 13:36 FAX 5087900249 GOLDMAN ASSOC 1IO2 ACaRD ".>b. RTIFICATE £fir LIA—BUiY" U T CSR AW 12/02-04 PRGOUC — E-R - TP.IS CERTIFICATE IS lSSUEO AS A MATTER OF WFORMATTON �OL:,�S:,;r' & AS:iOCIATES 1N. CE ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE $Y.*14NCIAL S$ILVICBS INC. HOLDER. THIS CERT)F CA7s DOES NOT d!!END. EXTEND OR 933 FALMOUTH .R.D- .ALTER THE COVERAGE AFFORDED BY THE POLIES BELOW. HYANNIS MA 02601 Phcnat 508-775-6010 Fax:508-790-0249 iNSURERSAFFORDING COVERAGE I NAICA INSURED INSURERA: MARYLAND CASUALTY COMPANY ' INSURERS: t RODNPIY TAVA.t.7'O INSURERC: I DBA b03C'HANICAL SYSTEMS 110 LOLDER LANZ INSURER D: W BAS27STABLE MA 0266aa INSURERS LrVYCHAVGJ THE POLICIES OF INSU-ANC' LISTED BELOW HAVE BEEN MEL EO TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, T13ZM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES PE.5CRIft0 "MIN IS aU9JECT TO ALL THE TERM5; EIICLUSIONS AND CONORIDNS OF SUCH ' POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS LTA INSR TYPE OF INSURANCE I POLICY NUMBER DATE MMID POL DA E WO - LIMITS - i A GENERALLMeLJ1Y . II X COMMERCIALGENERALL"LITY CuJMS MAD. F7 OCCUR 000372088 11/21/04 11/21/05 EAC4OCCURRENCE S 1000000 PPSIt s( admenY) I a 300000 MED ExP (M+Y w+e wa ) I S 1000 0 PERSONAL t ADV INJURY I S 10 00 00 0 I - GENERAL AGGREGATE S 2000000 — GENT AGGFM GATE LIMIT APPLIES PEA: PRODUCTS • COMP/OP AGG E Z O O O OO O I POLICY 77 PRO- Fj LOC i AUTOMDE": LIABILITY COMBINED SINGLE LIMB (Ez zcadertt) S ANY AUTO ALL OWNED AUTOS ( BODILY INJURY (Pn Pawl) SCHEDULED AUTOS I HIRED AUTOS I ?I�O AUTOS NON-OA' BOOZY INJURY {Per accident) S PROPERTY DAMAGE (Far accden0 S I flARA4E LIAI}ILl1"/ I AUTO ONLY -EA ACCIDENT >~ A TO NLAY: FJIAEL S . ANY Al71T] EXCcaaAWRELL.A LWi6TTY CLAIMS MADE EACH OCCURRENCE IS R'cGAic I AGGISLE I S I OCCUR I 3 j. RETENTIO4 •.. _S. _ __ _ _ ___-..— ____. __ .. _ _ ._ IIlIDRPMR3 COWENSATION AND I TORY LIMBS ER E.L FACM ACCLL:Ni S -kwLbY&w LIA&jTY ANY PROPRIETORIPARTNERJD MUTNE OFFICERIMEMSER I!YCLUDED'1 El- DISEASE -EA EWLO S E.L.DISEASE - POLICY LIMIT S III �X � � �dy' SPECIAL PROVISIO.LS below OTHER ..crime."iN WK=L-91 E.CL.........- ...-..w.......-....--.' 'FF.-'.-�'e%J' GG•�. Y'.YI� -. - r_a rmann SHOULD ANY OF THE ABOVE DF�-.0 ED POLI . BE CANCELLED BEFORE THE EXPIAAT ON DATE THEREOF. THE L%sUING INSURERVLL ENDEAVOR TO MAIL 30 DAYS WRRT@N NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL GICT luo Ramos INC-, IMPOSE NO OBLIGATION OR LIABILITY OF ANY )UND UPON THE INSURER, ITS AGENTS OR FAX 508-778-5603 1600 2ALMU= ROAD SUITS 25 tiEPAESFJtTATiVE4 CxNTIIRVILLE MA 02632 ArrH Ur REPRESENTATIVE II ACORD 25 (2001108) 3TdCORQCQRFORATRONT88>!• - 43aa� atw CERTIFICATE OF INSURANCE: DATE (MM DD,YY) 05—OG 05 f I THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION PRODUCER ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE GOLDMAN & ASSOC INS FIN HOLDER THIS CERTIFICATE DOES NOT AMEND,. EXTEND OR 933 FALMOUTH RD ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. RTE 28 HYANNIS MA 026012319 COMPANIES AFFORDING COVERAGE COMPANY 28HPP A AMERICAN ZURICH INSURANCE COMPANY INSURED COMPANY TAVANO, RODNEY OBA- B MECHANICAL SYSTEMS CAPES TRAIL COMPANY WEST BARNSTABLE MA 02668 C COMPANY D COVERAGES THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TOT INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. co TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE (MWDD\YY) POLICY EXPIRATIONLTS DATE (MMIDDNYY) OMITS _ GENERAL LIABILITY GENE.RALAGGREGATE S PRODUCTS-COMP/OP AGG. S COMMERCIAL GENERAL UABILITY CLAIMS MADE F OCCUR. PERSONAL & ADV. INJURY g - EACH OCCURRENCE S OWNER'S & CONTRACTOR'S PROT. FIRE DAMAGE (Any one fire) S MED. EXPENSE (Any one person) $ AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE UMIT $ ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per Person) S HIRED AUTOS NON -OWNED AUTOS BODILY INJURY (Per Accident) S PROPERTY DAMAGE S GARAGE LIABILITY AUTO ONLY - EA ACCIDENT S OTHER THAN AUTO ONLY: .5. .. _ ANY AUTO • EACH ACCIDENT AGGREGATE $ EXCESS LIABILITY _ EACH OCCURRENCE S UMBRELLA FORM AGGREGATE S ' OTHER THAN UMBRELLA FORM A WORKEWS COMPENSATION AND EMPLOYER'S LIABILITY (US-7278A84-9-05) 05-03-05 05-03-06 STATUTORY LIMITS . .. ............_,............_.:. EACH ACCIDENT S 100,000 THE PROPRIETOR/ PARTIERSlEXEOUTIVE INCL OFFlCERS ARE X IXCL OTHER DISEASE —POLICY LIMIT $ 500,000 DISEASE —EACH EMPLOYEE S 100,000 DESCRIPTION OF OPERATIONSILOCATIONSIVEHICLESIMSTRICTIONSISPECIIL ITEMS THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AFFECTING WORKERS COMP COVERAGE. CERTIFICATE HOLEIER CANCELLAT[OTi SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL GATE10 1600 FALOOD MOUTH RD SUITE 25 HOMES INC 600 AL DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR C ENT E R V I LL E MA 02632 LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. ACORII25Sr3f�3).:' AUTHORIZED REPRESENTATIVE � RGORiiCQ. 9953° x 1 v wig Ur YARMOUTH BUILDING DEPARTMENT CONSTRUCTION SUPERVISOR FORM PLEASE PRINT.- Job Location: I a , Number_ Owner of Property: V L Construction Supervisor.. Name Address: / 1?e ° 0 Licensed Designee: (If other than Supervisor) Name Village aly�o t„� IF . License No. license No. 2.15 Responsibility of each license holder: 96� No. 2.15.1 The license holder shall be fully and completely responsible for all work for which he is supervising. He shall be responsible for seeing that all work is done p as approved by the building official. ursuant to the state building code and the drawings 2.15.2 The license holder shall be responsible to supervise the construction, reconstruction, alteration, repair, removal or demolition involving the structural elements of building and structures onlypursuant to the state building code and all other applicable laws of the commonwealth, even though he, the license holder, is not the permit holder but only a subcontractor or contractor to the permit holder. 2.15.3 The license holder shall immediately notify the building official in writing of the discovery of any violations which are covered by the building permit. 2.15.4 Any licensee who shallwillfullyviolate subsections 2.15.1, 2.15.2 or 2.15.3 or anyother section of these rules and regulations and any procedures, as amended, shall be subject to revocation or suspension of license by the board. 2.16 All building permit applications shall contain the name, signature and license number of the construction supervisor who is to supervise those persons engaged in construction, reconstruction, alteration, repair, removal of demolition as regulated by section 109.1.1 of the code and these rules and regulations. In the event that such licensee is no longer supervising said persons, the work shall immediately cease until a successor license holder is substituted on the records of the building department. 2.17 The license holder shall be responsible for requesting all required inspections. Failure to do so may be deemed a violation of the permit conditions. I have read and understand my responsibilities under the rules and regulations for licensing construction supervisors in accordance with section 109.1.1 of the state building code. I understand the construction . inspection procedures and the specific inspection as called for by the building official. INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.152 Yes No If you have checked yes, please indicate the type coverage by checking the appropriate box. A liability insurance policy Er Other type of indemnity (] Bond OWNER'S INSU NCE WAVER: I aware that the licensee does_ _ not t have the insurance❑ coverage required by Chapte 1 .2o P ass. al a s, and that my signature on this permit application waives this requirement. iignat re of ner or Owner's Agen Check one: Owner ❑ Agent Signature: Building Official Approval: G OF ,yA� rn-o TOWN OF YARMOUTH O `3 TTAChr. ES 1146ROUTE28 SOUTHyARMOUTH MASSACHUSETTS02664- 451 MA Telephone (508) 398.2231, Ext. 261 — Fax (508) 398-2365 BUILDING DEPARTMENT DEMOLITION DEBRIS DISPOSAL AFFIDAVIT BUILDING ELECTRICAL GAS PLUMBING SIGNS Pursuant to M.G.L. Chapter 40, Section 54 and 780 CMR, Chapter 1, Section 111.5, I hereby certify that the debris resulting from the proposed work/demolition to be conducted at �, 5 Work Adc1ress is to be disposed of at the following location: n O01/7t �P_ � Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Chapter 111, Section 150A. Signature of Applicant Date Permit No. ING: REGULATIONS ION SUPERVISOR 2430L Fx�#r 60102006� Tr. -no: 25926 Restt3E�slatT� "j; 6RANK GCAPRM CENLE ALLE. MA 02632` - Commissioner 00-400Gdegdosed.space (MGL C.T4Z S.6oLJ tA-Masonrjs00i� �k-i£2•Fami'tjci-l0mes Failureto possess-acurrentedition oMe t : Massacn0setfsStaWBtinding.Code •' is cause::for••Tavo oi:[vf'6iis.nwnse. Ak i DIG SAFECALL.CENTER: 1888) 344-7133 PROPERTY ADDRESS; '.ALCULATION FOR PE_R_ COST Is XAi gj .53Y. M T y NO • of r� TOWN OF YARMOUTH Building Department _ Town Hall e Yarmouth, MA 02664 (508) 398-2231 ext.261 BBUILDING PERMIT TRANSMITTAL Temp Permit No.: T-06-066 Applicant Name: Frank Capra Applicant Phone: 5087789669 Building Location: 00121 CAMP ST Unit 105 Owner's Name: Villages @ Camp Street, LLC Owner's Addres 1600 Falmouth Road 9 25 Centerville MA 02632 Owner's Telephone: (508) 778-9669 REVIEWED BY: �1. WATER DEPARTMENT: 2. ENGINEERING DEPARTMENT: 3. CONSERVATION: IA. HEALTH DEPARTMENT: l 5. BUILDING DEPARTMENT: 6. FIRE DEPARTMENT: RECEIPT OF COPY: (OFFICE USE ONLY Recorded By: Ic Permit Fee: $0.00 Deposit Rec: $50.00 Payment Type: Check ChkNo.: 1033 Net Owed: ($50.00) Application Date:.8/15/2005 Issue Date: Expiration Date Comments: new construction: 044.21.1.C/05 ZONING APPROVE® to DATE: DATE: DATE: DATE: DATE: DATE: PLEASE NOTE SIGNATURE OF APPLICANT: N/A: N/A: N/A: N/A: N/A: N/A: DATE: Date Printed: 8/22/2005 • OF 1, TOWN OF YARMOUTH Building Department Town Hall Yarmouth, MA 02664 (508) 398-2231 ext.261 BBUILDING PERMIT TRANSMITTAL Temp Permit No.: T-06-066 Applicant Name: Frank Capra Applicant Phone: 5087789669 Building Location: 00121 CAMP ST Unit 105 Owner's Name: Villages @ Camp Street, LLC Owner's Addres 1600 Falmouth Road # 25 Centerville MA 02632 r Owner's Telephone: (508) 778-9669 (OFFICE USE ONLY Recorded By: Ic Permit Fee: $0.00 Deposit Rec: $50.00 Payment Type: Check ChkNo.: 1033 Net Owed: ($50.00) Application Date: 8/15/2005 Issue Date: Expiration Date Comments: new construction: AUG 2 4 2005 Map/Lot: 044.21.1 REVIEWED BY: 1. WATER DEPARTMENT: DATE: N/A: 2. ENGINEERING DEPARTMENT: DATE: N/A: 3. CONSERVATION: DATE: N/A: 4. HEALTH DEPARTMENT: DATE: N/A: 5. BUILDING DEPARTMEN DATE: N/A: 6. FIRE DEPARTMENT: DATE: N/A: PLEASE NOTE COMMENTS: RECEIPT OF COPY: SIGNATURE OF APPLICANT: DATE: Date Printed: 8/22/2005 TOWN OF YARMOUTH WATER DEPARTMENT 99 Buck Island Road West Yarmouth, MA 02673 Telephone: (508) 771-7921 • Fax: (508) 771-7998 Date of Issue : Aug 25, 2005 Letter of Water Availability 1. Single Family Dwelling X 2_ Duplex Family Dwelling 3. Condominium Dwelling 4. Commercial / Industrial 5. Other (Specify) Reference; Massachusetts General Laws Chapter 40, Section 54 To : Town of Yarmouth Building Inspector Please be advised that the Town of Yarmouth Public water supply is available to service lot/parcel(s) 21.1 Street 121 Camp St., #105 as shown on Assessors sheet/map # 44 Issuance of this Letter of Availability is subject to the following provisions/restrictions. (1) The property owner agrees to comply with all Federal, State, and Local Laws, Rules and Regulations as they pertain to the use of the Public water Supply. (2) The Yarmouth Water Department shall have exclusive rights as to the size, number, type and location of all water service lines, fire service lines or appurtenant items connected to the water distribution system. (3) The Yarmouth Water Department reserves the right to require, at the property owners expense, the installation of water mains and appurtenant items to meet water demand requisites within any structure relevant to this Letter.of Availability. (4) This Letter of Availability will expire 180 days from the date of issue. I have read and understand ti Water Availability. Reference Gatewood Homes 1600 Falmouth Rd., #25 : Centerville, MA 02632 Ya uth Water Department Am %0 r of TOWN OF YARMOUTH Building Department Town Hall Yarmouth, MA 02664 (508) 398-2231 ext.261 BBUILDING PERMIT TRANSMITTAL Temp Permit No.: T-06-066 Applicant Name: Frank Capra Applicant Phone: 5087789669 Building Location: 00121 CAMP ST Unit 105 (OFFICE USE ONLY Recorded By: IC Permit Fee: $0.00 Deposit Rec: $50.00 Payment Type: Check ChkNo.: 1033 Net Owed: ($50.00) Application Date: 8/15/2005 Issue Date: Expiration Date Comments: Map/Lot: 044.21.1.0 new construction: Owner's Name: Villages @ Camp Street, LLC Owner's Addres 1600 Falmouth Road # 25 Centerville MA 02632 Owner's Telephone: (508) 778-9669 REVIEWED BY: - ,1: WATER DEPARTMENT.------ ; DATE: /A: 2. ENGINEERING DEPARTMENT: DATE: N/A: 3. CONSERVATION: DATE: N/A: 4. HEALTH DEPARTMENT: DATE: N/A: 5. BUILDING DEPARTMENT: DATE: N/A: 6. FIRE DEPARTMENT: DATE: N/A: PLEASE NOTE COMMENTS: RECEIPT OF COPY: SIGNATURE OF APPLICANT: DATE: Date Printed: 8/22/2005 GMS9/GCS9.SER1ES . 93% AFUE Multi~.>Positionji... Single-Stage/Multi-Speed, Gas Furnace-.. -. Heating Capacity; . 46,000-115,000 BTUH art C:onditioriirig'& }{eatmg. The GMS9/GCS9 single -stage, multi=speed-gas furnaces offer- installationversatility,. Standard Features CabinecEomtraction • Corrosion -resistant, aluminimd•steel tubular heat • Heavy -gauge. reinforced, fully insulated steel cabinet exchanger and stainless -steel recuperative coil for with dumb)e baked -enamel fm(s}, - maximum efficiency • Attractive architectural gray Paint finish • Designed for multi -position installation--GMS9':' • Foil -face insulation -lined heat exchanger upflow, horizontal right or left•, GCS9: downflow, horizontal right or left • Energy -saving, reliable Hot Surface Ignition system, featuring a Norton® Mini•Igniter.with patented adaptive learning algorithm to maximize igniter life • Ahiminized-steel inshot burners • Energy -saving PSC; mulu=dpeed; direct drive blower motor • Quiet, cotrosion•resistant induced -draft blower assembly • Integrated furnace controlwith•improved_..... diagnostics • Low voltage terminal blocks • Multiple flame rollout switches, blower door safety switch, outlet air -limit switch and Pressure switch for proof of combustion air • 40VA transformer for heating and air conditioning control service - • Combination redundant gas valve and regulator • Top venting -is standard; alrerare Ruetvenrlocated- an right side • Completely.assembled.fauogttum:cestedfurttace.for.. _. heating or combination heatiagkoohng application • All models comply with California NOx Standards • Suitable for direct vent (2•pipe) or non -direct vent (I -pipe) applications compartment Coil and furnace fit flush for easy installation Convenient left or right connection for gas acid electric service f)ottom or side air inlet (GMS9) Removable. solid -bottom block -off (GM59)✓ iecessoriis- • L.P. Conversion Kit (LPTOOA) •- L:P.-Gas Lory PressumKit• (LPLP01) • High Altitude Natural Gas/L.P Kits (HANGI I. HAN012, HALPIO) ... . • High Altitude Pressure Switch Kit (HAPS27) • ExternalFikerRack(EFROI) • Horizontal Concentric Vent Kit (HCVK) • Vertical Concentric Vent_Kit(VCVK).. • internal Filter Retention Kit—upflow, horizontal (RF000IBO) - • Internal Filter RetenZim� Kit—down{low _ (RFOOolm • Thermostats Blower Motors (CHT18,60. CH70TG, CHSATG, H2i3TWR) SS•3770 Vodwnmfg.com 6/04 ww PgQQUQT SPECIFICATIONS - Nomenclature Nomenclature M 5 8 070 Goodman® Brand .Air Flow Direction tk UpflawItHiorizonEW8....... D: Dedicated Downflow, C. Downflow/Horizontat a met Width ft. HfAir Flow 8.17 Description S. sinite StAge/Muilti. speed S. P; 24'A" Two Stage/Variable-Weed Maximum CFM 0 0.5" ESP AFUF 8: W% ] 4; 1,600 9; 90% 5: 2,000 045* 45,000 ... 670: 70,000 090: 90,000 140.140,000 PRODUCT SPECIFICATIONS GCS9 Dimensions _ LEi%ElF Rew ADE Va IE"'�7 VIEW ri „ a US aA ' vs vFArnwa r.F IA er rl"F IRE'hMnuR) rm rvvC tins r , LCW VOLTMt[ _I t� EIEMRKM "OtF' L J arwn Mo. VCLTA(ie ELECTAC.I"DI.F IIAAw TAN r sn.I - . L&T foe —/a'� DMwtw[ .0 Ia ut isles aTAND.RD Wa 1/1r3 sue"tTllola J • vs a Ime roloro ra,.Ay@ca V ay GCSW4533XA=24A"zr. 12s/" " t6"GCS9070)BXA.... 12%" 14H"' " "16"GC590904CXq" 16%" 18" 19WGES91155DYA._. 2Dr/ee.' . 2154" 23" NOTES! I. Installer must supply one a two PVC pipes: one for combuscWna"uptionali fndotleianheflae outlet (requited). Vent pipe muse be either 2"or )' in diameter. depending upon furnace input; numberof e8m". length of run andinatallation (I or 2 pipes). The optional Combustion Air Pipe is dependent on inetallariorJcode requirements and must be 2" or )" diatneter PVC. 2. Line voltage wiring can enter thhwgh thrrght or lefrsideof-rhe (urnace. Lowy voltage wiring eanenter thrtlugh the rlghr o, left side of furnace. ). Conversion kits for high altitude natural gas opermlon ate available. Contact your Caodman disnibutoT or dealer hx details. 4. Insallet must supply "10" 4 Gros line fittings, according to which mvanceiE used: Left —Iwo 900 elbows. one cline ruppIc. straight pipe Right —Straight pipe to reach gas valve Minimum Cl'earanees to Combustible Materials Cn"pERFTf •- DRAWTAM r lew vOtT1N)E RI VA'AVC / ELECTRCAI MOLE DL7C11aAnE.... ... .. M ...... a IRIMTtM MtalVralADa- L@er alDrl FLlCTRCAL MAr D N e IPo I�OCMA�iOM 3 Mlles • ALTERN•TE ... .. .. N1Po .. -. ... uR Wr fMYw � TAYa It vl WnRi BIDE ... .. .. .. w tat4w CRR ....� rlDtEf 3 /1 Po a A r �ITERNATE dV Q _ .... _. atw ...... auePl!"oLE_. L �'pl,!^Iwac �iwsQl4Hl.vNF�. .. rolDiO h� baeWADE MIt C + C/lnlbustiblt: If placed on eumbustible f)ooE the pour MUST be vgod ONLY. NC w Non•Combrntiblr. A combustible poor subbase must be used for installation on enmbwnble flooring NOTES: • For servicingof c(eaning, a 36" front Clearance urecommended. - • Unit clmncctions (eltttttcd. flue and drain) may neeessiare greater cicarancea thaa.tha mtaimumelnnncn 1ltred babes: • 20 all area, accessibility clearance must take precedence Duet clearanaeahom the enclosure whets xeeaeltrif(ry ckanoces an gteattr. 5 r Blower Performance Specifications r14 ME `.::. .Mz sPMAI HIGH 3 01,318 r 1,260. ---• . 1,202G_590453BXA MED 2.5 1,17Z 1,123 1,064 (LOW MED-l0 2.0994 LOW.. - .1:5_...753 14.. 794 45 .76t- ...,r . 41 .` G_59070381(A HIGH MED 3.0 2.5 1,449 1,192 36 43 1,409 1,172 37 44 1,326 t,141 39 1,273 (MED•Hf)' ' 'MED-LO ' '2.0 981 S3" 96Z 54 943 45 35 1,094 917 47 56 LOW 1.5 750 730 1 ------ 1 714 40-' - 44 G_590904CXA . HIGR - MED _.40.. 3.5 1,970 1,713 ^----- 39 4,874- 1,650 ' 35 :F 40 57- 72 ..3b- 42 1-,6%7- t,510 (MED-LO) MED-LO 3.0 1,439 46 1,412 47 70 48 1,327 501 ` Low 2.5' 1 183 '56 a ass "57"2I 59 ` 11101I 6D s. 3; ; ii 4a1 . HIGH 5.0 2,134 40 2,103 40 29 42 t,94t G 591155DXA .MED 4.0 1,614 ..51. 1,643 _ 52. 52. t,577 ..54.. (MED-MI) MED-1-0 3.5 ,453 5 1,440 59 1,426 59 ,363 62-3-0.1M9 ' .. 67 1239 .t643 8 220 70 t .*��:'�. NOTES: I • CFM in ehnrt is without filter(s). Filters do not eltip.with.this furnace. but muxt l+wpcueided.bytlta.InstaU,it.Jf thc.hun tieyuiree.txtt.reIT this than assumes both 611w are inamlled. 2. All furnaces ship as high speed cenling. Insadler meat adjust Mower corAlnp speed as needed. 3. For most itms. ahior 400 CFM per ton when cl-ling is drsirahle. 4. INSTALLATION IS TO BE ADJUSTED TO OBTAIN TEMPERATLtRF. RISE WITHIN THE RANGb SPECIFIED ON ME RATING PLATE. 5. The chart is for InhNmatism only.. For sarisfactory operation, external static press,,re meat not exceed value 6110wn on the •sting plate The shaded aree indicates rang¢. In excess of maximum static pressure eltuwcd when hcetiny. 5. The dashed (--••) areas indlcare a teNtpesatruelixnot rteommended ft"*rMr 4el, 7. The above chart is fin U.S. furnaces installed at 0' • 2.0p0'. At higher altitudes. a properly de•rated unit will have approximately the same temperature rise at a p, rtkulsr CFM,whdi: ESP at the CFM wi8be.htwer, _ .. Wit.. PRODUCT SPECIFICATIONS Accessories LP7-OOA L.P. Conversion Kit LPLPOt L.P. Gas Low Pressure Kit r HANG11 HANGIT HALP10 HAPS27 .. EEROt.. High Attitude Natural Gas Kit High Attitude Natural Gas Kit High Altitude L.P. Gas Kit High Attitude Pressure Switch Kit External Fllter.Rack....... 1 2 ) 3 - _. _. i.... _ .. 1 2 3 3 t Z ....1.._ 3 „ ....7. _ 1 2 3�. 3 DCVK-20 Horizontal/Vertical Concentric Vent Kit (2") ✓ DCVK-30 Horizontal/VerticatConcentrieVent ititt}")- 1' (1) T,001*to 9,Q00' "Nc (2) 9,001'to 11,1000' (3) 7,001' to 11,000' Note: All Inatallations above 7,000'teVolre a ptessure switch claaege: Fix natailerionin (hmada, furnacel are certified only it) 4,500. DownAow floor Base: When the GCS 9 ma(el (, installed directly on a wood floor, a down0ow floor base must be urad..Thoaa awdtl numbeui, arc. CFBl7, CFB21 and CTB21. Thermostats CHTIS-60 CH70TG CHSATG H2OTWR Cooling/Heating, Mechanical Cooling/Hosting, Digital, Non -programmable Heating Only, Mechanical J 7 MAScheck COMPLIANCE REPORT Massachusetts Energy Code MAScheck Software Version 2.01 Release 2 CITY: Yarmouth STATE: Massachusetts HOD: 6137 CONSTRUCTION TYPE: 1 or 2 Family, Detached HEATING SYSTEM TYPE: Other (Non -Electric Resistance) DATE: 4-16-2004 DATE OF PLANS: 04/16/04 PROJECT INFORMATION: Mill Pond Village Camp Street Yarmouth, MA 02673 COMPANY INFORMATION: Northside Design Assoc. 141 Main Street Yarmouth Port, MA. 02675 COMPLIANCE: PASSES HOUSE MODEL: MALLARD Required UA = 245 Your Home = 140 I I I I Permit # I I I I Checked by/Date I I Area or Cavity Cont. Glazing/Door ------------------------------------------------------------------------------- Perimeter R-Value R-Value U-Value UA CEILINGS 865 30.0 30.0 15 WALLS: Wood Frame, 16. O.C. 1631 .15.0 15.0 72 GLAZING: Windows or Doors 109 0.340 37 GLAZING: Windows or Doors 40 0.340 14 DOORS ------------------------------------------------------------------------------- 20 0.086 2 COMPLIANCE STATEMENT: The proposed building design described here is consistent with the building plans, specifications, and other calculations submitted with the permit application. The proposed building has been designed to meet the requirements of the Massachusetts Energy Code. The heating load for this building, and the cooling load if appropriate, has been determined using the applicable Standard Design Conditions found in the Code. The HVAC equipment selected to heat or cool the building shall be no greater than 125% of the design,load as specified in Sections 780CMR 1310 and J4.4. Builder/Designer Oat Massachusetts Energy Code MAScheck Software Version 2.01 Release 2 i DATE: 4-16-2004 Bldg.1 Dept.1 Use I CEILINGS: 1. R-30 + R-30 Comments/Location WALLS: 1. Wood Frame, 16. O.C., R-15 + R-15 Comments/Location WINDOWS AND GLASS DOORS: 1. U-value: 0.34 For windows without labeled U-values, describe features: # Panes Frame Type Thermal Break? [ ] Yes [ ] No Comments/Location 2. U-value: 0.34 For windows without labeled U-values, describe features: # Panes Frame Type Thermal Break? [ ] Yes [ ] No Comments/Location DOORS: 1. U-value: 0.086 Comments/Location AIR LEAKAGE: Joints, penetrations, and all other such openings in the building envelope that are sources of air leakage must be sealed. When installed in the building envelope, recessed lighting fixtures shall meet one of the following requirements: 1. Type IC rated, manufactured with no penetrations between the inside of the recessed fixture and ceiling cavity and sealed or gasketed to prevent air leakage into the unconditioned space. 2. Type IC rated, in accordance with Standard ASTM E 283, with no more than 2.0 cfm (0.944 L/s) air movement from the the conditioned space to the ceiling cavity. The lighting fixture shall have been tested at 75 PA or 1.57 lbs/ft2 pressure difference and shall be labeled. VAPOR RETARDER: Required on the warm -in -winter side of all non -vented framed ceilings, walls, and floors. MATERIALS IDENTIFICATION: Materials and equipment must be identified so that compliance can be determined. Manufacturer manuals for all installed heating and cooling equipment and service water heating equipment must be provided. Insulation R-values and glazing U-values must be clearly marked on the building plans or specifications. 0 h APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code, (MEC), 527 CMR 12.00 p (OFFICE USE ONLY) TOWN OF YARMOUTH AS ByO11l.� GGGZ 3 Fee: $ Uv O I PERMIT NO. p % P �3J /•Z (PLEASE PRINT IN INK OR TYPE NFORMATIBN Date: 3Z? J / 6 6 To the Inspector of Wires: By this application the undersigned gives notice of his or her i Y ntion to perform the electrical work described below. / C� / �4 Location (Street & Numbed �� ` �t /+'11 i� / `l2 h%o !/ T �� (�yj / D,3 Owner or Tenant G Telephone No. Owner's Addressc�C���P/! Is this permit in conjunction with a building permit? 3-0! es ONo (Check Appropriate Box) / Purpose of Building t L Rlf—l� Utility Authorization No. L! ��/ 6 6 Existing Service A� / Volts Overhead Undgrd [7) No. of Meters New Service le!L AmpsI V4 //�?D .Vooits Overhead Undgrd � No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed electrical Work: No. of Recessed Fixtures _..... .. ........ No. of Ceil: Sus . Paddle Fans ..... .........r. ...�... ...., „�..u.vcuo me uu cuw o cruet No. of Kota Transformers KVA No. of Li Lighting Outlets No. of Hot Tubs Generators KVA No. of Li htin Fixtures Above n- SwimmingPool rnd. md. No. of Emergency Lighting BatteryUnits No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches 3 No. of Gas Burners o. of Detection an Initiating Devices No. of Ranges g Total No. of Air Cond. Tons No. of Alerting Devices No. of Waste Disposers C� Heat Pump Totals: Num er ors W - - No. of Self -Contained Detection/Alerting Devices No. of Dishwashers f Space/Area Heating KW Local Municipal Other Connection No. of Dryers Heatin A liances KW g PP Secutity Systems: No, of Devices or E ui valent No. of Water Heaters KW No. of No. of Signs Ballasts Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or E uivalent V4� Attach additional detail if desired, or as required by the Inspector of Wires. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may be issued unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same ,th, o the permit issuing office. L� p �f CHECK ONE: INSURANCE BONDC) OTHER (Specify:) O � (Expiration Date) Estimated Value of Electrical Work: f 5 (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion. I certify, under the pains and penalties of erjury, that the information on this application is true and complete. 4&RMNAME: 57c Pbr C t,/O LIC. NO. censee: S<me Signature LIC. NO. `Z (If applicable, enter "exempt" in the license number live.) t Bus. Tel. No.: Address G �4 r'`� Alt. Tel. No.: OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) owner owner's agent. Owner/Agent Signature Telephone No. / [Rev. 04/00] WPS - Permit • Work Order Information • • Page 1 of 1 iNSTAR WPS - Permit U6Tity AUUMO #: 01510M Date: 03292006 Company JACQUELINE MELLO Rep: Report By: YAR 121 CAMP ST UNIT105 VILLAGES AT CAMP ST Status: PLAN Service: NEW Type: RES Nature of Work: NEW HOME ... 100A U/GR...NEW U/GR DEV...DEV.IS LIVE .... # 090... P100D... 1400 SQ.FT..... GAS HEAT, HOT WATER ..ELETRIC RANGE, DRYER dr NO A/C Service Information: There is no Service Information. Permit Information Permit #: E06-890 Meters: 1 Reseal (YIN): Y Date: 06242006 Inspector. WI0060 Description: Search Detail Contacts NSTARRHHome WPS Lopon WPS Help Comments WO Request WPS News low Copyright 2003 NSTAR, 800 Boylston Street, Boston MA USA. All rights reserved. Reproduction in whole or In part of any graphics, Images, text or other content at this web site must be granted by NSTAR, Boston, MA, USA. Unauthorized modification of any Information stored at this site may result in criminal prosecution. http://www.nstaronline.comlappslwpslwpspermit.cfm?Page=Permit&Unique= f ts_'2006-0... U24/2006 APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK PON Is this permit in conju tion with a building permit? 2rYes QNo (Check Appropriate Box) Purpose of Buildingy7k� Utility Authorization No. Existing Service Amps / Volts Overhead Undgrd C3 No. of Meters New Service L12C' Number of Feeders and Location and Nature of Proposed electrical Work: No. of Meters_ /'n nlofin n(fAn IMI ..... --,-A I . A.. ...J L.. sL- L. _t'na•__. No. of Recessed Fixtures No. of Ceil.-Sus . Paddle Fans No. of Total Transformers KVA No. of Lighting Outlets No. of Hot Tubs Generators KVA No. of Lighting Fixtures Above Cj In- SwimmingPool d. md. No. of Emergency Lighting Batte Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners o. o Detection an Initiating Devices No. of Ranges Total No. of Air Cond. Tons No. of Alerting Devices No. of Waste Disposers Heat Pump Totals: um er ors — — K — No. of Self -Contained Detection/Alerting Devices No. of Dishwashers S ace/Area Heating KW p g Local Municipal Connection Other No. of Dryers Heating Appliances KW Secutity Systems: f Devi No. oces or E ui valent No. of Water Heaters KW No. of No. of Signs Ballasts Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or E uivalent firracn aaamonai aerau V aesrrea, or as requzrea by the Inspector of Wires. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may be issued unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to permit issuing office. CHECK ONE:, R URANCE 2r BOND C] OTHERO (Specify:) Estimated Valu oo �1eI ical Work: Work to Start: '� In pections to be requf I certify, under the p ' s and a ies f peter ury, a 1 I� *RM NAM • _ censee:�Sigm (If applicable' gptph"exe tj ' the license 4umber line.) OWNER'S INSURANCE WAIVER: I am aware that the Liceksee does below, I hereby waive this requirement. I am the (check one) owner Owner/Agent (Expiration Date) (When required by municipal policy.) accordance with MEC Rule 10, and upon completion. tin on is application is true and complete. LIC. NO. �w. w�... LIC. NO, Bus. Tel. No.: Alt. Tel. No.:: t have the liability insurance coverage normally required by law. By my signature owner's agent. 11 Signature [Rev.04/00] Telephone Commonwealth of Massachusetts ° Use °�Y l/ y , ... ... Permit No. 0 Department of Fire Services v:r-- �upanty and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS . il/991 veblank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All waicto be performed in scowduice with the Massachusetts Electrical Code (MEC); 527 CMR 12.00 (PLE4SE P= 1Y.MKORTYPEALL INFi7RMAT10NJ Date: City or Town of: YARMOUIH To the Impector of Wires: , (� application the undemigaed gives notice of his or her intention to perform the electrical work described below. " e _� on (Street & Number) MILL POND VILLAGE, 121 C V St Eldg # 10 �a;N O or Tenant Gatewood Hares/ Jeff Sollows Telephone No. 50 8-7 7 8 9 6 6 9 O es Address .1600 Fallmutli Rd., Suite 25, Centerville, Ma. 0263.2 —' is permit in conjunction with a building permit? Yes El' No Check Appropriate Box P J gP ❑ () p Q Pa of Bailding single family residence Utility Authorization No. ' g Service � .Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters ervice Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters Number ofFeeders and Ampacity Location and Nature of Proposed Electrical Woric Fire Alarm System (low voltage control panel) wi h backlgl'batterv.'centrall,/ monitored. Com letioh o the ollowin table be inzived-h the r o ii'ires o: o otal No of Recessed Fixtures No. of Ceil -Susp. (Paddle) Fans Transformers KVA No. of Lighting Outlets No. of Hot Tubs Generators KVA No. of Lighting Fixtures Swimming Pool Above d. ❑ Batte UniOT�eits in g • No. of Receptacle Outlets No. of Oil Burners FIRE AT.ARMS No. of Zones -1-' No. of Switches No. of Gas Burners No. of Detecdonand7 InitiatingDevices No. of Ranges No. of Air Cond. Tons No. of Alerting Devices No. of Waste Disposers t ump Number. Tons o. o ontaine Totals: DetectiontAler-tinz Devices 7 No. of Dishwashers Space/AreaHeating KW Local 0 C=2ion ® Om�r No. of Dryers Heating Appliances KW ISecurity stems: No. of -Devices brE uivalent o. of Watef, o. o o. o Data Wining: Heaters Sim Ballasts No. ofDevices ore uivalent Na Hydromassage Bathtubs No. of Motors Total IfP iaecommunications Wiring, No. of Devices orEquvalent oTBICk. Attach vMtfanal datail tfdistre4 or as rrgWred by thehupector c'Wires. . INSURANCE COVERAGE: Unless waived by the owner, no.permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" .coverage or its substantial equivalent The uudensigrfed certifies that such coverage is in force, and has exhibited proof of same to.the permit issuing office. CHECK ONE: INSURANCE M BOND p OTRER 0 (specify ) Vfiw n to Estimated value of Electrical worm $750. oo _ (When required by municipal policy.) Work to Start inspections to be requested in accordance with MEC Rule 10, and upon completion. Icertify, under thepains andpenaldes ofperjury, that the information on this application /strue and complete FIRM NAME: Baltic Security, Inc LIC. NO. 1178C Licensee: Jonas R Bielkevicius Signature LIC. NO.: 499D •(ffapplicrlble,enter'ezmpt"inthe, license.trtattb lam1l 02563 BusTeLNo.• 508-833-0996 Address: ' l'0 liox .J 609. Sandwact, 1ya. Alt: TeL No.; 508-7 —3 7 OWNER'S INSURANCE WAIVER .I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement I am the .(check one) ❑ owner ❑ owner's agent Owner/Agent Signature Telephone No. PEWIRTFEE: $ 40.'00. 3� OF y49�'c --TOWN, OF YARMOUTH MAT A�EESE / D_52 66, APPLICATION FOR PERMIT TO DO PLUMBING (OFFICE USE ONLY) By AV-q. Fee: $ IQ ! iQQ fA Qba0' PERMIT NO. P Ob — Date Building Owner's ����/S0&z4:0 {/S AT: Location S-T Name New Plans Submitted novation ❑ Yed No ❑ Type of Occupancy Replacement ❑ �l P Z NY Z OQ O F Z a <aa7 WW -� O y Z� N= _ w n Y LL w O waW 2a w G Q y J Z tY G Oi U. CO 3 Z O Wp O VK =O plMl/�a r_ y Y J H u. DM`T. ra (q G O J 2 co C7 7 G Q 1X m O SUB-BS BASEMENT 1ST FLOOR 2ND FLOOR' 3RD FLOOR (PRINT OR TYPE) Installing Company Name Address Check One: ❑ Corp. ❑ Part whip 0.z 1 " Ic 'EtaLam" ! " Fir /Com a Business Telephone ��� 7 ef 5r5�Name of Licensed Plumbe � %`f%uf�L(%'T(`��Tv� INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent. Check One: Yes Er- No ❑ If you have checked YES, please indicate the type of coverage by checking the appropriate box. A liability insurance policy ❑ Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Signature or Owner or Owner's Agent I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. Type: Master 0 License Number Journeyman DRIVEWAY ..IEMEN� /f/7 46:2 I0.69' 1 1 . •r�5.2 EXISTING I CERTIFY THAT THE FOUNDATION IS LOCATED IN FLOOD PLAIN ZONE C AS SHOWN ON FLOOD. INSURANCE RATE MAP COMMUNITY PANEL NO. 250015 0005D AND THAT FLOOD PLAIN ZONE C IS NOT A SPECIAL FLOOD HAZARD AREA./ W Zi 2m5 DATE REGISTERE6 PRO ESSIONAL LAND SURVEYOR NOTICE Unless and until such time as the original (red) stamp of the responsible Professional Engineer, or Professional Land Surveyor appears on this pion: (A) no person or persons. Including any municipal or other public officials. may rely upon the Information contained herein; and (B) this plan remains the property of Holmes dr McGrath. Inc. EXISTING FOUNDATION LOT .11 \Ss en 1 L:tK I II• T INA I IML FUUNUA I IUN IS LOCATED ON THE LOT AS SHOWN, AND THAT ITS LOCATION CONFORMS TO THE MINIMUM SETBACK REQUIREMENTS 07 THE 40B SPECIAL PERMIT. )V DATE REGISTERED P OFE SIONAL LAND SURVEYOR GRAPHIC SCALE ( IN FEET ) 1 inch = 20 ft. AS —BUILT PLAN holmes and mcgrath, inc. OF LOT 105 civil engineers and land surveyors PREPARED FOR 362 gifford street MILL POND VILLAGE falmouth, ma. 02540 IN YARMOUTH, MA. JOB No: 2011' 97 DRAWN: LMC SCALE: 1"=20' DATE: 11-21-051 DWG. NO.: A2543A CHECKED: i OF fACHAEL B. MCGRATH No. 289M i� NOV 3.0 00 BUILDIN DEP . l \ �/ 9li� ng corp. _.,..,... CONSULTING ENGIt-JEERS 716 CouWStreet, TaurtanMA02780 Tel, (508) 822-6934 Fax. 008) 880.7811' FieldDensif Test Re rf -Sand Cone Method AS M D 1556 Client: Gatewood Homes 1600 Falmouth Road, Suite 25 Job No. 10980Date: 05 N Report No.: Centerville, MA 02632 o.: 6 6 Project: Mill Pond Village, West Yarmouth Test No. Location of Field Dens Test FD5307A Unit #105 - N Center - Fooling Grade : Sandy Material F05307B Unit #105 - S Center - Footing Grade - Sandy Material FD5307C Unit #106 - SW Comer - Fooling Grade - Sandy Material FD5307D Unit #106 - NE Corner - Footing Grade Sandy Material FD5307E Unit #107 - W Center - Footing Grade - Sandy Material FD5307F Unit #107 - E Center - Footing Grade_ Sandy Material Tabulation Field Density Test Results Date: Test No. Proctor I.D. Req, % Obtained Meets Moisture Dry Wt Max Dry Optimum Compl Compaction Specs. Content P C.F. Wt. PCF Moisture 111312005 FD5307A PR4252E 95 99.3 Yes 8.2 125.5 ' 126.4 8.2 11rW005 FD5307B PR4252E 95 99.6 Yes 6.9 125.9 . 126.4 8.2 11/3/2005 FD5307C PR4252E 95 973 Yes 66 123.3 ' 126.4 8.2 11/3I2005 FD5307D PR4252E 95 994 Yes 7.6 125.7 ' 126.4 8.2 11/3/2005 FD5307E PR4252E 95 99.0 Yes 6.6 125A 126.4 8.2 1102005 FD5307F PR4252E 95 98.2 Yes 6.5 124.1 126.4 8.2 Remarks: All tests met the specified minimum 95% compaction. Corrected for Oversize Particles in accordance with ASTM D-4718. M. White Walter P. Galuska Laboratory Technician Laboratory Supervisor OF 1, TOWN OF YARMOUTH Buitding departmentBUILDING rok'( --------__, (508)398-2231ext.261 PERMIT NO g-06-449 _ PERMIT .� ISSUE DATE ; _ 9/29/2005 _ PROPO us APPLICANT 'Funk Capra_ _ _ _ _ JOB WEATHER CARD -------- _ _ _ _ _ _ _ _ _P PERMIT TO 'New Construction ' AT (LOCATION). 100121CAMP ST Unit 105 '; ZONING DISTRIC R-2 Bldg. Type: Residential SUBDIVISION MAP LOT BLOCK 044.21.1.C105 BUILDING IS TO BE: CONST TYPE 5-e USE GROUP R-4 LOT SIZE new construction: 2 baths, 3 bedrooms, 1 kitchen/dining area, 1 livingroom as per plans dated REMARKS 08/30/05. NOTE: SUBJECT TO COMPACTION AND PROCTOR TESTS AREA (SQ FT) EST COST ($ I$146,400.00 PERMIT FEE ($) 1$534.00 OWNER I Villages @ Camp Street, LLC UILDING DEPT ADDRESS 11600 Falmouth Road # 25 ap ey Centerville I MA 102632 1✓'' CONTRACTOR LICENSE 012430 Capra, Frank 1600 Falmouth Road #25 Centerville MA 02632 5087789669 Certificate Issue Date � � � 4- ;CERTIFICATE of .'OCCUPANCY Departmental Approval for Certificate of Occupancy and Compliance �..�......f... nafn Dermit Mumhnr onnrnved By Remarks [7 fAO4 ,'W'•_, F®A `\ A409 Will ENGINEERING To be filled in by each division indicated hereon upon completion of its final inspection.